What Else Can We Use? Alternative Fixation Methods of the Volar Lunate Facet Fracture of the Distal Radius

Purpose

The anatomy of the “critical corner” in volar lunate facet fractures makes achieving fixation difficult, and standard precontoured volar locking plates may be limited in certain fracture patterns. The purpose of this review was to identify various fixation techniques for the volar lunate facet and review the outcomes data associated with each fixation method.

Methods

A review of the literature was performed by first screening the PubMed database for relevant articles using key terms: “volar lunate facet,” “critical corner,” and “distal radius fractures.” Two reviewers independently assessed all 87 articles for relevance. Articles were included if both reviewers agreed on their inclusion and if they described an alternative fixation method for treating volar lunate facet fractures. The reviewers then extracted as much data as possible regarding the fixation methods, including technique, sample size, follow-up period, and various outcomes such as range of motion, grip strength, return to work, and rates of union.

Results

Of the 28 articles that were included, the fixation methods reviewed were categorized into direct Kirschner wire fixation, compression fixation—“spring wire fixation,” tension fixation—“wire-loop fixation,” and containment fixation with the use of a buttress pin in various configurations. These alternative fixation methods had high rates of union, few complications, and good to excellent clinical outcomes.

Conclusions

The limitations of using a single volar locking plate for volar lunate facet fractures have led to the development of novel fixation techniques. Although these alternative fixation methods have demonstrated promising outcomes, the existing studies have small sample sizes.

Clinical relevance

Distal radius fractures involving the volar lunate facet present a challenge in operative fixation due to the various anatomical features described. Each unique fracture pattern must be thoroughly evaluated to determine the most appropriate fixation method.